Aromatherapy and Massage - Midwifery Clinical Guideline V3 ......Aromatherapy is the use of essential oils, which can be administered by topical application via massage, inhalation

Aromatherapy and Massage - Midwifery Clinical Guideline

V3.1

March 2019

Aromatherapy and Massage - Midwifery Clinical Guideline V3.1 Page 2 of 17

Summary

Increased demand for midwives to support the use of complementary therapies is now widely accepted across the whole spectrum of the childbearing cycle (Royal College of Midwives 2014).

Aromatherapy is the use of essential oils, which can be administered by topical application via massage, inhalation or dispersed in water. It is reputed to promote relaxation, whilst relieving stress, anxiety and tension. Evidence suggests that women and their birth partners are using aromatherapy on their own initiative, at times without relevant knowledge (Pallivalapila et al. 2015). There is also an increasing amount of research to support the use of massage as a method of pain control during the latent and first stages labour (Jones et al. 2012). It is therefore a skill that midwives may benefit from having an understanding of, and may aid them in supporting their patients in the use of aromatherapy oils.

1. Aim/Purpose of this Guideline

1.1. Aromatherapy and massage are increasingly requested by some pregnant women. This guideline is to guide Midwives on their safe utilisation within Royal Cornwall Hospitals Trust (RCHT) maternity services. 1.2 Aromatherapy can provide benefits to clients in the antenatal, intrapartum and postnatal periods. Women’s choices during pregnancy and birth should be advocated for, but they should also be informed that few complementary therapies have been established as being safe and effective during pregnancy due to the lack of quantative research. This lack of research has resulted in women being advised to be cautious in the use of therapies during childbearing and birthing (NICE 2017).

2. The Guidance

2.1. Professional Accountability of midwives using massage and aromatherapy

2.1.1. In order to advise on use of aromatherapy and massage to women accessing our services, Midwives need to attend the Trust training day and complete our Trust workbook. 2.1.2. The Nursing and Midwifery Council (NMC) allows midwives to use complementary therapies in their practice when they have been “adequately and appropriately” trained to do so. Each midwife is accountable for her or his own practice and must be able to justify any actions (Tiran and Mack, 2000). The Trust provides adequate and appropriate training, and recommends Midwives base their practice within the parameters of the Trust’s Aromatherapy and Massage for Midwives Guideline. 2.1.3. The Midwives’ Rules and Standards (NMC 2015) allow Midwives to use aromatherapy oils and to massage clients, but only with informed consent and in interest of that client.


2.1.4. Midwives should endeavour to remain up to date with current evidence, and be able to evidence this as part of revalidation, if they are working with essential oils and massage in practice.

2.2. Operational Policy

2.2.1. A register of midwives who have completed the Trust training package will be held within the Division, by the Lead Massage and Aromatherapy Trainer. The status of clinicians is their own responsibility to keep updated. 2.2.2. The request or assessed need, implementation and evaluation of individual aromatherapy and/or massage treatment will be documented in the woman’s maternity records as per Trust training recommendations. 2.2.3. The midwife will only practice aromatherapy or massage treatments subject to the availability of time and the needs of the service. Clinical midwifery commitments must take priority. 2.2.4. Referral • Women are to self-refer • Women can provide their own oil blends, as outlined in the Trust Aromatherapy Information Leaflet for Expectant Mothers or midwives can prepare an oil blend for the woman they are supporting following assessment of need and risk.

2.3. Recommended Oils

The following oils are the recommended for antenatal care use:

Oil Basic Properties Basic Uses Basic side-effects Peppermint Mentha piperita

Analgesic Energising Antispasmodic

Alleviates general nausea, may help with morning sickness, good as support to those with hyper-emesis.

Powerful aroma- can be overwhelming. May irritate sensitive skin. Keep away from eyes.

Orange Citrus sinesis

Antidepressant Uplifting Antispasmodic Energising

Soothing for those with antenatal depression.

Sedative. Avoid strong sunlight (phototoxic). May irritate sensitive skin.

The following oils are the recommended components of blends for induction of labour and for birthing:

Oil Basic Properties Basic Uses Basic side-effects

Frankincense Boswellia carteri/thurifera/oilbanum

Anti-inflammatory Calming Uterotonic

Ground and centre. Useful during transition. Useful for pain relief, to reduce anxiety and aid tension release.

Strong smell. Avoid with asthmatics.

Chamomile Chamaemelum

Analgesic Febrifuge

A very soothing oil easing anxiety, tension,


nobile/anthemis nobilis stress and fear. Promotes relaxation, gives patience and calms.

Lavender Lavendula officinalis/angustifolia

Analgesic Restorative

This oil has strong pain-relieving qualities. Enhance uterine action. Aids wound healing and reduce inflammation.

Aroma can be overpowering. Not for use of hypotensives. Not for use on those with hay fever related asthma.

Jasmine Jasminium grandiflorum/officale

Anti-septic Parturient Uterotonic

This oil is reputed to strengthen contractions and help relieve pain at the same time. It is balancing and restoring. Useful in management of induction, said to accelerate labour, and to aid expulsion of retained placenta.

Aroma can be overpowering and cause nausea.

Clary Sage Salvia sclarea

Strong uterotonic Anti-septic Sedative

To encourage labour – excellent for use in induction and acceleration. Useful in expulsion of placenta.

Strong scent. Feelings of euphoria. To be used with caution in clinical settings where other pain relief is in use.

The following oils are recommended for use postnatally:

Oil Basic Properties Basic Uses Basic Side Effects Lavender Lavendula officinalis/angustifolia

Post- natal healing and analgesia

Perineal healing - 1 drop in 500mls warm water – pour over following urination This oil has strong pain-relieving qualities. Enhance uterine action. Aids wound healing and reduce inflammation.

Aroma can be overpowering. Not for use of hypotensives. Not for use on those with hay fever related asthma.

Additionally Chamomile may be used in the postnatal period as an analgesic oil.

2.3.1. Methods of Use

Massage is a recommended means of use, and supported by training provided to Midwives at this Trust.

Use in a bath, as a compress, and in inhalation are also supported by the Trust


Use of oils directly into a birthing pool is NOT recommended due to increased slip hazard. 2.3.2. Blend Strength Guidelines for massage:

Number of drops to be added per:-

Percentage blend required

5ml of carrier 10ml of carrier

15ml of carrier

20ml of carrier

1% Pregnancy and Postnatal

1 2 3 4

2% Labour 2 4 6 8

3% Induction of labour for postdates pregnancy

3

6 9 12

Guidelines for other uses:

2.3.2.1. Bath (NOT for use in birthing pool)

4 - 6 drops of essential oil added to 2mls carrier oil add to bath after the bath is filled. Re-run bath but do not top up with water/oils

Do not use in bath if rupture of membranes has taken place 2.3.2.2. Compress

4 drops of essential oil in 1 litre of water for pain or cold water for swelling

Soak large swab, wring out and apply to skin

When swab is the same temperature as the skin re-soak and reapply to the skin

Do this as often as required BUT do not add more essential oil if water is topped up 2.3.2.3. Inhalation

Vaporisers/diffusers contraindicated to use in ward settings: do not use.

Inhalation by 2 drops of neat oil onto tissue for immediate use. The tissue can be placed in a lidded pot for ease of use and removal of source if required.

2.3.3. Storage of Oils

Essential Oils will be stored in a locked cupboard.

Once blended, oils must be clearly labelled with women’s name, time and date, blend strength and contents.


2.4. Induction of Labour

2.4.1. The Trust supports the use of aromatherapy oils and/or massage techniques to support the process of induction of labour for those women who have no contraindications, and who have had a documented risk assessment performed. 2.4.2. The use of aromatherapy oils for inpatient induction of labour will be at the discretion of the midwife providing care, with compassionate consideration given to other ward inpatients. Ideally, induction of labour with use of aromatherapy will take place within a designated ward area (bay/side room).This will be supported by literature and advice given to women accessing services antenatally. 2.4.3. The use of aromatherapy oils for outpatient induction of labour will be on request of the women accessing services, and following a documented risk assessment with the midwife providing induction of labour counselling.

2.5. Contraindications to massage:

Broken/open/weeping skin

Skin allergies

Infected or sore skin conditions

No massage on burns, even sunburn

No massage on inflamed/ bruised areas, undiagnosed lumps and bumps

Unhealed fractures or other acute injuries (wounds)

Keep massage light when lochia still present

Any history of haemorrhage

No abdominal massage with previous Caesarean section or history of manual removal of placenta or an anterior placenta

Pyrexia, illness or infection

Polyhydramnios/oligohydramnios

Spontaneous/Artificial Rupture of Membranes – wait 60mins (this is cautious).

Varicose veins and history of deep vein thrombosis

2.6. Contraindications and precautions to aromatherapy use:

Awareness of baby lie – avoid use if transverse, unstable, oblique lie, and obviously with non- cephalic presentation not wishing to deliver vaginally.

Be mindful of multiple pregnancy – proceed with caution with twins and do not advocate use for triplets and above.

Never advocate oils to a client with epilepsy – with either current or historic history.

Proceed with caution when working with diabetic women – do not advocate use for insulin dependent women or those with unstable blood sugars.

Proceed with caution when advising women in preterm labour.

Asthma, Respiratory conditions


Major cardiac, renal, or hepatic disease

Pathological anaemia

Haematological disorders

Thromboembolic disorders

Coagulation disorders – especially clients taking anticoagulant therapy

Deep vein thrombosis history

Unwell women, with pyrexia or infectious conditions, will not benefit from use of aromatherapy oils within our care parameters – avoid their use.

Hypertension – consistent readings of diastolic raised above 90mmHg – do not advocate use.

Women with fulminating eclampsia (PET)

Antepartum haemorrhage

Placenta praevia

Do not advocate use for mothers planning caesarean section delivery.

Do not advocate use for mothers planning to use pethidine, or epidural as pain relief in labour.

ARM/SROM within last hour

Leave one hour from induction interventions – for example pessary insertion

Once syntocinon is in use, avoid use of aromatherapy oils.

Avoid essential oil use in the postnatal period until feeding is established.

2.7 Additional contraindications particular to infant massage: (New 2019)

When you are noticing a cluster of disengagement cues / ‘consent’.

Massage / oil on umbilicus before it is fully healed

Consider dehydration element on neonates if extended time enjoying massage

Use judgement on phototherapy ‘bronzed’ babies.

Massage on inflamed/ bruised areas, undiagnosed lumps and bumps

Abdominal massage after a full feed

Temperature (consider heat loss implication for the neonate)

Illness or infection – use judgement on babies coping well with prophylactic antibiotic therapy

24 hours since an immunisation shot

Caution with preterm infants

2.8 Essential Oil Safety

Do not take essential oils internally

Most essential oils should not be directly used onto the skin

Take care that undiluted essential oils do not come into contact with sensitive areas i.e. eyes, nose, face, neck


Wash hands thoroughly after using oils in massage

Keep essential oils away from naked flames, they are highly flammable

Keep essential oils away from children and babies

All essential oils must be labelled

2.9 Dealing with Adverse Skin Reactions

Adverse reaction may affect anyone coming into contact with essential oils

Skin

Wash skin with unperfumed soap (located in clean utility room cupboard) to remove oil

Expose skin to air to encourage evaporation of the oil

Eyes

If undiluted essential oil is accidentally splashed into the eyes: Flush the eyes with clean warm water, saline eye wash

Other

Remove person suffering adverse reaction from oil source, or oil source from vicinity of person.

For any accident or adverse reaction with oils, complete a Datix form detailing incident and persons involved.

Wash hands thoroughly after using any essential oil

2.10 Disposal of Unused Oil

Plastic pots containing oils should be soaked up with a tissue which is then disposed of in a yellow clinical waste bag

Water containing essential oils used for compresses/footbaths should be disposed of down the sluice sink

Baths/bowls should be thoroughly cleaned with hard surface wipes following the use of essential oils

2.11 Consent

2.11.1 Women should be provided with sufficient knowledge to make an informed decision about the use of aromatherapy (NMC 2015). 2.11.2 Verbal consent is sufficient, but must be documented in the written midwifery notes. 2.11.3 Women should be made aware that the decision to use or not use oils does not affect their subsequent care. 2.11.4 Midwives are required to document the consent and indication discussion, together with rationale in the Midwifery notes. Discussion should include information about the essential oil(s) and the reason for application.


2.11.5 Massage should also be verbally consented, and documented, before administration of any strokes or holistic touch. 2.11.6 Please complete the Massage and Aromatherapy Audit and Feedback Sheet (Appendix 4)

3 Monitoring compliance and effectiveness

Element to be monitored

Use of Aromatherapy

Adverse outcomes

Women’s experience

Documentation

Consent

Lead

Janey Ashton

Audit Midwives

Tool See Auditing Tool – Appendix 3

Frequency Within the year of the introduction of this guideline or earlier if concerns. For at least the first year, this will be on a rolling monthly basis and will look at each case where aromatherapy was used

Reporting arrangements

Obstetric Patient Safety Forum or Clinical Audit Forum

Acting on recommendations and Lead(s)

Any deficiencies identified on the report will be discussed at the Maternity Forum /Clinical Audit Forum and an action plan developed.

Action leads will be identified and a time frame for the action to be completed.

The action plan will be monitored by the Maternity Forum /Clinical Audit Forum and an action plan developed.

Change in practice and lessons to be shared

Individual feedback to midwife

Patient Safety Newsletter

Reported via the Patient Safety Forum and the Clinical Audit Forum.

The training package is progressive and will inform staff of any changes in practice that are required.

4 Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website.

4.2 Equality Impact Assessment

The Initial Equality Impact Assessment Screening Form is at Appendix 2.

http://www.rcht.nhs.uk/GET/d10268876

http://www.rcht.nhs.uk/GET/d10268876

http://www.rcht.nhs.uk/RoyalCornwallHospitalsTrust/OurOrganisation/EqualityAndDiversity/HumanRightsEqualityAndInclusion.aspx


Appendix 1. Governance Information

Document Title Aromatherapy and Massage - Midwifery Clinical Guideline V3.1

Date Issued/Approved: 7th March 2019

Date Valid From: 7th March 2019

Date Valid To: 7th March 2022

Directorate / Department responsible (author/owner):

Janey Ashton

Contact details: 01872 252150

Brief summary of contents

This guideline gives guidance to Midwives upon the use of Aromatherapy Oils and Massage in labour.

Suggested Keywords: Aromatherapy, oil, essential, massage, labour, placenta, retained, pain

Target Audience RCHT CFT KCCG

Executive Director responsible for Policy:

Medical Director

Date revised: 7th March 2019

This document replaces (exact title of previous version):

Aromatherapy - Clinical Guideline For Midwives V3.0

Approval route (names of committees)/consultation:

Maternity Guideline Group Obs and Gynae Directorate Divisional Board Policy Review Group

Divisional Manager confirming approval processes

Care Group Manager

Name and Post Title of additional signatories

Not Required

Name and Signature of Divisional/Directorate Governance Lead confirming approval by specialty and divisional management meetings

{Original Copy Signed}

Name: Caroline Amukusana

Signature of Executive Director giving approval

{Original Copy Signed}

Publication Location (refer to Policy on Policies – Approvals and

Internet & Intranet Intranet Only


Ratification):

Document Library Folder/Sub Folder Clinical/Midwifery and Obstetrics

Links to key external standards None

Related Documents:

Bastard J, Tiran D 2006 Aromatherapy and massage for antenatal anxiety: its effect on the fetus. Complement There Clinical Practice. 12(1) P. 48-54

Battaglia S 2004 The Complete Guide to Aromatherapy. The Perfect Potion Australia.

Burns, E., Blamey, C., Ersser, S. J., Barnetson, L., & Lloyd, A. 2000 An investigation into the use of aromatherapy in intrapartum midwifery Practice. The Journal of Alternative and Complementary Medicine, 6(2), p. 141-7.

Burns E, Zobbi V, panzeri D, Oskrochi R, Regalia A 2007 Aromatherapy in childbirth: a pilot randomised controlled trial. British Journal of Obstetrics and Gynaecology 114 (7) p 838-44.

Fanner F 2005 The Use of Aromatherapy for pain management through labour. International Journal of Clinical Aromatherapy. Vol 2 10-14

Fowler P. William 1997 COSHH/CHIPS Ensuring the Safety of Aromatherapy

House of Lords 2000 Select committee on Science and technology. 6th report. CAM London.

Lawless J 2002 Encyclopaedia of Essential Oils: the complete guide to the use of aromatic oils in Aromatherapy, Herbalism, Health & Well being. Thorsons, Harper Collins, London

Lewith G, Jonas W & Walach H 2002 Clinical Research in Complementary Therapies. Churchill Livingstone.

NICE 2017 Antenatal Care For Uncomplicated Pregnancies [online] https://www.nice.org.uk/guidance/cg62/resources/antenatal-care-for-uncomplicated-pregnancies-975564597445


NMC 2008 Complementary & Alternative Therapies & Homeopathy. NMC London

Tiran D 2016 Aromatherapy In Midwifery Practice, Singing Dragon, London

Tiran D 2014 Aromatherapy In Midwifery Practice: A manual for clinical practice 4th edition Expectancy, London

Training Need Identified? Aromatherapy training for core midwives on the Birth Unit

Version Control Table

Date Version

No Summary of Changes

Changes Made by (Name and Job Title)

17th December 2015

V1.0 New Issue Angela Whittaker Supervisor of Midwives

4th January 2018

V2 Review and updated by birth unit team and related documents updated

Sandra Hogan, Birth Unit manager

V2.0 Review and updated by birth unit team and related documents updated

Sandra Hogan, Birth Unit manager

4th October 2018

V3.0 Amended document to include massage and aromatherapy.

Janey Ashton, Midwife/Lizzie Anstey, Midwife.

7th March 2019

V3.1

Addition of the baby massage contraindications and Massage and Aromatherapy Audit and

feedback sheet Appendix 4. Watermark attached re sweet orange oil.

Janey Ashton, Midwife/Lizzie Anstey, Midwife.

All or part of this document can be released under the Freedom of Information

Act 2000

This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing

Controlled Document

This document has been created following the Royal Cornwall Hospitals NHS Trust Policy for the Development and Management of Knowledge, Procedural and Web

Documents (The Policy on Policies). It should not be altered in any way without the express permission of the author or their Line Manager.


Appendix 2. Initial Equality Impact Assessment Form

This assessment will need to be completed in stages to allow for adequate consultation with the relevant groups.

Name of Name of the strategy / policy /proposal / service function to be assessed Aromatherapy And Massage- Clinical Guideline For Midwives V3.1

Directorate and service area: Obs & Gynae

Is this a new or existing Policy? Existing

Name of individual completing assessment: Janey Ashton/Lizzie Anstey

Telephone: 01872 252159/01872 251107

1. Policy Aim*

To give guidance to Midwives on the use of Aromatherapy and Massage in pregnancy and labour

2. Policy Objectives*

To give guidance to Midwives on the safe use of Aromatherapy and Massage in labour

3. Policy – intended Outcomes*

Safe use of Aromatherapy and Massage in pregnancy and labour

4. *How will you measure the

outcome?

Compliance Monitoring Tool

5. Who is intended to benefit from the

policy?

Pregnant women and their babies

6a Who did you consult with b). Please identify the groups who have been consulted about this procedure.

Workforce Patients Local groups

External organisations

Other

X

Please record specific names of groups Maternity Guideline Group Obs and Gynae Directorate Divisional Board Policy Review Group

What was the outcome of the consultation?

Guideline agreed


Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Unsure Rationale for Assessment / Existing Evidence

Age x All pregnant women

Sex (male,

female, trans-gender / gender reassignment)

x All pregnant women

Race / Ethnic communities /groups

x All pregnant women

Disability - Learning disability, physical impairment, sensory impairment, mental health conditions and some long term health conditions.

x

Religion / other beliefs

x

Marriage and Civil partnership

x

Pregnancy and maternity

x

Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian

x

You will need to continue to a full Equality Impact Assessment if the following have been highlighted:

You have ticked “Yes” in any column above and

No consultation or evidence of there being consultation- this excludes any policies which have

been identified as not requiring consultation. or

Major this relates to service redesign or development

8. Please indicate if a full equality analysis is recommended. Yes No

x

9. If you are not recommending a Full Impact assessment please explain why.

N/A

7. The Impact Please complete the following table. If you are unsure/don’t know if there is a negative impact you need to repeat the consultation step.


Signature of policy developer / lead manager / director Janey Ashton

Date of completion and submission November 2018

Names and signatures of members carrying out the Screening Assessment

1. Janey Ashton 2. Human Rights, Equality & Inclusion Lead

Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD This EIA will not be uploaded to the Trust website without the signature of the Human Rights, Equality & Inclusion Lead. A summary of the results will be published on the Trust’s web site. Signed Sarah Jane Pedler Date March 2019


Appendix 3. Monitoring Compliance and Effectiveness

Guideline Audit Tool

Audit Questions

1 Were only the recommended essential oils used?

2 Was consent documented in the notes?

3 Were any adverse reactions noted?

4 What method/s of aromatherapy was used – Massage, compress, inhalation via tissue?

5 Was massage used?

6 Did use of aromatherapy improve patient experience?

7 Did use of massage improve patient experience?

8 Was there appropriate documentation relating to the standards set in the training package?

Applicable Guideline Aromatherapy and Massage – Midwifery Clinical Guideline V3.0 November 2018

Audit Register Number (For audit use)

Process Retrospective

Audit Date (For audit use)

Auditor (For audit use)


Appendix 4

Practitioner Name: Place

Patient LOCATION: Sticker Here! DATE:

________________________________________________________________________

MASSAGE AND AROMATHERAPY AUDIT AND FEEDBACK SHEET MIDWIFE: PLEASE FILE FOR MONTHLY COLLECTION BY THE LEAD TRAINER FOR MASSAGE AND AROMATHERAPY IN THE

LOCATION AGREED WITH YOUR MANAGER (NOT IN PATIENT NOTES!)

Please tick each that you documented in main PATIENT NOTES notation: Consent Methods used Volumes/Blends if applicable Reasoning Documentation outcome/effectiveness/patient satisfaction Did you use massage? Yes / No Consent to teach partner to perform massage? Yes / No / N/A Did you use a base oil? Yes / No Did you use aromatherapy? Yes / No What method of administration was used? (please detail blend strength or drop quantity as appropriate) Which oils did you use? Adverse reaction – No Yes- please explain to whom and the reaction, and action taken: Datix completed? Yes/No (If you can give the reference number here we would SO happy and grateful!) Any further comments?: Patient/user feedback is appreciated – if your patient would be happy for one of our Key Worker Midwives in this area to contact them for some further information or as a follow up, please leave us their contact number here so that we may do so (Verbal Consent gained):

PLEASE REMEMBER YOU ARE MORE THAN WELCOME TO ATTEND THE DROP IN TEACHING SESSION ON BIRTH CENTRE LAST THURSDAY OF EVERY MONTH AT 10.30-12.00 TO DISCUSS ANYTHING ABOUT USING TOUCH, AROMATHERAPY,

OILS AND MASSAGE IN YOUR CLINICAL PRACTICE OR EMAIL [email protected] (LEAD TRAINER)

mailto:[email protected]